Is the use of emergency departments socially patterned?
To analyse the association between patients’ socioeconomic position (SEP) and the use of emergency departments (EDs).
This population-based study included all visits to ED in 2012 by inhabitants of the French Midi-Pyrénées region, recorded by the Regional Emergency Departments Observatory. We compared ED visit rates and the proportion of non-severe visits according to the patients’ SEP as assessed by the European Deprivation Index.
We analysed 496,388 visits. The annual ED visit rate increased with deprivation level: 165.9 [95% CI (164.8–166.9)] visits per 1000 inhabitants among the most advantaged group, compared to 321.9 [95% CI (320.3–323.5)] per 1000 among the most disadvantaged. However, the proportion of non-severe visits was about 14% of the visits, and this proportion did not differ according to SEP.
Although the study shows a difference of ED visit rates, the probability of a visit being non-severe is not meaningfully different according to SEP. This supports the assumption that ED visit rate variations according to SEP are mainly explained by SEP-related differences in health states rather than SEP-related differences in health behaviours.
KeywordsPrimary access to care Social inequalities in health Emergency department Administrative database
Compliance with ethical standards
All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Formal consent was not required for this study. The Midi-Pyrénées ED observatory database was declared to the French National Commission for Data Protection and Liberties (CNIL): declaration n°761 633 (31/08/2001). For analysis and cross-referencing data between databases, permission was obtained from the Committee on the Treatment of Research Information in the Field of Health (CCTIRS) and from the French National Commission for Data Protection and Liberties (DR-2013-579 N°913509 Decision). In France, the CCTIRS and CNIL assessed the ethical and juridical aspect of the protocol.
Conflict of interest
All authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work. The authors declare that they have no conflict of interest.
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